When Is It Appropriate For Arthrodiastasis Of The First MPJ?

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This photo shows the patient after the surgeon has performed debridement and distraction.
Here one can see a radiograph of the distraction.
When Is It Appropriate For Arthrodiastasis Of The First MPJ?
A 63-year-old patient presented for surgical consultation with a history of a painful right first metatarsophalangeal joint. This preoperative D/P radiograph reveals significant degenerative joint disease with subchondral sclerosis and widening of the fir
When Is It Appropriate For Arthrodiastasis Of The First MPJ?
30
Author(s): 
By Peter M. Wilusz, DPM, and Guy R. Pupp, DPM

   Preoperative radiographs were significant for a dorsal medial enlargement of the metatarsal head, significant degenerative joint disease with subchondral sclerosis and widening of the first metatarsophalangeal articulation.

   Intraoperatively, we found significant adaptation of the first MPJ, including periarticular spurs and loose bodies. We debrided the joint of all loose bodies and hypertrophic synovium, and drilled the cartilage defects. We aggressively mobilized the sesamoid apparatus with a McGlamry elevator and performed an aggressive dorsal metatarsal head remodeling. We proceeded to perform joint distraction.

   The patient remained non-weightbearing for the first week. We loosened the articular hinge at seven days postoperatively and instituted range of motion and weightbearing. The distractor remained in place for five weeks. The patient currently is enjoying normal activities without pain at 18 months.

In Summary

   Arthrodiastasis is a new and exciting option for patients with painful motion secondary to cartilage defects in the first MPJ. Results are predictable with proper execution of the procedure to maintain a pain-free functional joint.

   There are three key benefits to arthrodiastasis. It provides mechanical offloading. It facilitates early range of motion, which allows the synovial fluid to bathe the chondrocytes to maintain health. Lastly, distracting the joint helps the subchondral bone recover from abnormal stresses and decreases the amount of subchondral sclerosis on radiographs.

   Indeed, joint distraction can be a valuable alternative to joint destructive procedures in otherwise healthy, active patients.

Dr. Wilusz (left) is a Clinical and Surgical Instructor at the Foot and Ankle Clinic at the Southeast Michigan Surgical Hospital in Warren, Mich. He is an Associate of the American College of Foot and Ankle Surgeons.

Dr. Pupp (right) is the Clinic Director of the Foot and Ankle Clinic at the Southeast Michigan Surgical Hospital in Warren, Mich. He is a Fellow of the American College of Foot and Ankle Surgeons, and is also the Clinic Director at the Sinai Grace Diabetic Foot Center in Detroit.

Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons, and is board certified in foot and ankle surgery. Dr. Burks practices in Little Rock, Ark.




References:

1. Chang TJ. Stepwise approach to hallux limitus: A surgical perspective. Clin Podiatr Surg. 13:449-459, 1996.
2. Magnan B, Bragantini A. Use of external minifixation in orthopedic deformities and diseases of the foot. In: Cziffer E, editor. Minifixation. External fixation of small boones. Budapest, Hungary: Szekszardi Nyomda; 1994. p187-96.
3. Buckwalter JA: Evaluating Methods of Restoring Cartilagenous Articular Surfaces. Clin Orthop 367(suppl):224-238, 1999.
4. Vanroermund, et al. Foot Ankle Clin N Am Sept 2002 and AAOS Annual Meeting 2001.
5. Orthofix, Inc. Applications by Anatomic Site. Richardson, TX:Orthofix p80-86.



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